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General NPI Number Information
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NPI Number | 1649864877
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Entity Type | Organization
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Legal Business Name | JENNIFER ALDAWOODI DMD, PROFESSIONAL CORP
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Dates
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Enumeration Date | 02/28/2021
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Last Update Date | 02/28/2021
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Provider Practice Location Address
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Address Line | 5531 CANCHA DE GOLF STE 102
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City | RANCHO SANTA FE
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State | CA
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Zip | 92091-4625
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Country | US
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Telephone | 858-367-3058
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Fax | 858-225-5954
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Provider Business Mailing Address
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Address Line | 5531 CANCHA DE GOLF STE 102
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City | RANCHO SANTA FE
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State | CA
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Zip | 92091-4625
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Country | US
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Telephone | 858-367-3058
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Fax | 858-225-5954
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHRINA AGATEP
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Credential | DDS
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Telephone | 858-367-3058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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